SuperPATH入路髋关节置换术治疗股骨颈骨折的早期疗效评价

Short-term effect of hip arthroplasty through the SuperPATH approach for femoral neck fractures

背景:老年性股骨颈骨折的发生率及病死率均很高。随着微创理念及快速康复理念的发展,SuperPATH入路的髋关节置换术逐渐用于该病的治疗。目的:探讨SuperPATH入路髋关节置换术治疗老年性股骨颈骨折的早期临床疗效。方法:回顾性分析2015年6月至2017年5月采用SuperPATH入路髋关节置换术治疗的50例GardenⅡ、Ⅲ、Ⅳ型老年性股骨颈骨折患者。同期行外侧Hardinge入路髋关节置换术治疗的老年性股骨颈骨折48例纳入对照组。比较两组切口长度、手术时间、术中出血量、术后下地时间、术后Harris功能评分及VAS评分。结果:所有患者术后均获随访6～18个月,平均10.5个月。两组手术时间比较,差异无统计学意义(t=-5.17,P=0.264)。SuperPATH组切口长度、术中出血量,术后下地时间均少于对照组,差异有统计学意义(P<0.05)。SuperPATH组术后1、6个月髋关节Harris功能评分显著高于对照组(P<0.05)。SuperPATH组术后1 d、1周的VAS评分显著低于对照组(P<0.05),而术后4、6周VAS评分比较,两组差异无统计学意义(P>0.05)。结论:采用SuperPATH入路髋关节置换术治疗老年性股骨颈骨折具有创伤小,出血少,术后疼痛轻,下床时间短,术后髋关节功能恢复快等优点。

Background： Femoral neck fracture is a disease which threatens elderly＇s life and health seriously, with increasing incidence and fatality rates. With the development of minimally invasive technology and enhanced recovery after surgery,hip arthroplasty through the SuperPATH approach has become the mainstay operation for the disease. Objective： To investigate the short-term effect of hip arthroplasty through the SuperPATH approach for femoral neck fractures in elderly patients.Methods： A total of 98 patients of femoral neck fractures（Garden Ⅱ, Ⅲ, IV） undergoing total hip arthroplasty or femoral head replacement from June 2015 to May 2017 were enrolled in this study. The operations were performed through SuperPATH approach in 50 patients（SuperPATH group） and through Hardinge approach（control group） in 48 patients. The incision length,operation time, intraoperative blood loss, ambulation time were recorded. The Harris hip score（HHS） at 1 month and 6 months after operation and the visual analogue scale（VAS） at 1 day, 1 week, 4 weeks, and 6 weeks after operation were compared between 2 groups. Results： The follow-up period ranged from 6 to 18 months（mean, 10.5 months）. There was no significant difference in operation time between 2 groups（t=-5.17, P=0.264）. SuperPATH group had shorter incision length, less intraoperative blood loss and earlier ambulation time than control group（P〈0.05）. The HHS at 1 month and 6 months after operation in SuperPATH group were significantly higher than those in control group（P〈0.05）. The VAS scores at 1 day and 1 week after operation in SuperPATH group were significantly lower than those in control group（P〈0.05）, while there were no significant differences between 2 groups in VAS scores at 4 weeks and 6 weeks after operation（P〈0.05）. Conclusions： Compared with the Hardinge approach, the SuperPATH approach shows the advantages in smaller trauma, less blood loss, slighter pain, shorter ambulation time and faster recovery in treatment of femoral neck fracture.